INTRODUCTION
Hyaluronic acid (HA) fillers have become increasingly popular in non-surgical rejuvenation procedures. They are easy to administer and help in addressing various cosmetic concerns, making them a popular option among practitioners. Moreover, their reversible nature and excellent safety profile have led to increased use.
Immune reactions are uncommon but well-described following HA-fillers and can be either immediate or delayed. Delayed immune reactions (DIRs) may present as nodules, edema, and/or erythema. Various triggers for DIRs have been described. Herein, we add to the literature three cases of DIRs to HA-fillers: one triggered by a motor vehicle accident, one following significant plant exposure while gardening without gloves, and another following an episode of contact dermatitis after laser resurfacing.
Case 1
A 57-year-old woman with phototype-IV skin presented to our clinic on May 2nd, 2018, concerned about volume loss and facial aging of the lower third of the face. She had deep wrinkles in the marionette lines and oral commissures, with mildly prominent nasolabial folds. Her medical history included osteoarthritis and herpes simplex. She had no drug allergies or history of autoimmune disease.
Based on her cosmetic goals, 1 mL of Restylane® Refyne was injected in the nasolabial folds and marionette area, and 1 mL of Restylane® Defyne was injected in the secondary smile lines following three rounds of disinfecting with alcohol and chlorhexidine-based solution. The injection of these HA fillers was performed in a deep subdermal plane. Areas of filler placement were subsequently molded and massaged to minimize clumps. No visible or palpable nodules were present upon discharge (Figure 1A and 1B).
